Electronic Transactions Overview in Healthcare System

1. Lesson 1 Overview of the 837 and 835

2. Section 1: Overview • Introduction • How did we get to where we are now? • What do electronic transactions mean to you and your coworkers? • How is IHS making it easy for you? • Where are we now?

3. Successful electronic transactions require action from: Patient Registration Business Office Finance Whom Do Electronic Transactions Affect?

4. Section 1: Overview • Introduction • How did we get to where we are now? • What do electronic transactions mean to you and your coworkers? • How is IHS making it easy for you? • Where are we now?

5. Why Electronic Transactions? • Makes good business sense • Revenue will increase • Cash flow will even out • It supports mission of providing highest quality health care to all American Indians, Alaska Natives, and those served by urban facilities

6. Why Electronic Transactions? (cont’d) • Addresses important patient rights issues • Privacy • Protects patient records so only the right people have access to them • Accountability • System tracks who accesses records and when • Efficiency • Reduces time spent on paperwork

7. Why Electronic Transactions? (cont’d) • It’s the law • In 1996 Congress passed Health Insurance Portability and Accountability Act (HIPAA) • HIPAA includes section on Administrative Simplification • Makes possible electronic transmissions using standard record formats, code sets, and identifiers • No specified date for compliance • But members should show “good faith efforts” working toward compliance

8. DHHS Rules Defining HIPAA • Transaction and Code Set Standards (Final) • Privacy Standard (Final) • Security Standard (Final) • National Provider Identifier Standards (Final)

9. New and Old Formats 837I (Institutional) replaces UB-92 837P (Professional) replaces HCFA-1500 837D (Dental) replaces ADA forms 837COB (Coordination of Benefits) Used to submit claims to secondary payers 835 replaces NSF forms Focus of Training: 837 and 835 • Health Claims & Equivalent Encounter Information or the 837 • Health Care Payment & Remittance Advice or the 835

10. Section 1: Overview • Introduction • How did we get to where we are now? • What do electronic transactions mean to you and your coworkers? • How is IHS making it easy for you? • Where are we now?

11. What Does It Mean For You? Site Manager: “Each year it has increased our collections dramatically.” Financial Management Officer: “This really helps identify problems.” Accounting Officer: “You will know exactly what’s going on.”

12. Section 1: Overview • Introduction • How did we get to where we are now? • What do electronic transactions mean to you and your coworkers? • How is IHS making it easy for you? • Where are we now?

13. How IHS Makes It Easy For You • The RPMS tools you need are ready • The materials you need are on hand • Problem solving is ongoing and best practices are being developed • Help is available

14. Transaction Tool 837-Third Party Billing and 835-Accounts Receivable Generic Interface Software (GIS) GIS v3.01, p2 & p5 (Optional) 837-Third Party Billing Institutional, Professional and Dental Claim Requests 3rd Party Billing, v2.5, p6 837-Third Party Billing Provider/Location Taxonomy AUT Patch v98.1, Patch 13 837-Third Party Billing Manually Adding Provider Taxonomy provides instructions to add provider and location taxonomy codes. As a backup, third party RPMS software (3P) uses crosswalk to find taxonomy number. 997 Functional Acknowledgement and Comp Report Macro has been developed to convert error report format into a list of segment lines for easier interpretation. 835-Accounts Receivable Claim Replay, (Remittance Advice) Accounts Receivable, v1.7, p4 835-Accounts Receivable Standard Adjustment/Reason Codes Accounts Receivable, v1.6, p4 RPMS Tools Are Ready

15. Materials Are On Hand • HIPAA Compliance: Business Transactions (for Area HIPAA Coordinators) • Trailblazers Medicare Part A: 837 Testing and Production Procedures (sent to all Area Offices) • Trailblazers Medicare Part B: 837 Testing and Production Procedures (sent to all Area Offices) • HIPAA 835 Testing and Production Procedures (sent to all Area Offices)

16. What Does It Mean For You? Management Program Analyst: “We want everyone to become HIPAA compliant, and this is a tool to help sites get to that point.”

17. Focus of This Training • 837: Preparation for Testing • 837: Electronic Claims Submission • 837: Reading Error Reports and Making Corrections • 835: Testing and Posting the Remittance Advice

18. Problem-Solving Ongoing • Regular OIT internal technical meetings • OIT holds regular national I/T/U conference call to discuss Area status reports, issues and solutions, and best practices • To participate in this call, notify ITSC Help Desk http://www.ihs.gov/GeneralWeb/HelpCenter/Helpdesk/index.cfm

19. Help Is Available • OIT Help Desk

20. Section 1: Overview • Introduction • How did we get to where we are now? • What do electronic transactions mean to you and your coworkers? • How is IHS making it easy for you? • Where are we now?

21. Current Testing Status

22. What Does It Mean For You? Financial Management Officer: “It will be a whole lot easier for everybody.” Accounting Officer: “Just keep on moving forward because you’ll come out successful.”

23. Lessons Learned • Electronic transactions are required: • For good business practice • To protect patient rights • By law • IHS provides: • RPMS tools • Training materials • Problem-solving and help